title: Acute spinal subdural hematoma with hemiplegia after acupuncture: a case report and review of the literature.
abstract: BACKGROUND
  Subdural spinal hematoma (SDH) is a very rare entity; however, it can lead to serious complications resulting from injuries to the spinal cord and roots. Although acupuncture has been a popular method for the management of pain control, we encountered the first case of SDH after acupuncture.
  
  
  OBJECTIVE
  The purpose of this case report was to present the first case of subdural hematoma after acupuncture and the reasons for the risks of blind cervical acupuncture.
  
  
  METHODS
  A case report and review of the previous literature are presented.
  
  
  METHODS
  A 69-year-old man complained of progressive weakness in the right upper and lower extremities 2 hours after acupuncture on the cervical spine and back. The diagnosis was delayed because of unilateral weakness, and the symptom was initially misinterpreted as a transient ischemic attack because of no sensory change and pain and normal findings of two brain magnetic resonance imaging (MRI).
  
  
  RESULTS
  Cervical MRI 36 hours after onset revealed acute hematoma from the C3-C5 level; hematoma showed an isointensity on T1-weighted image (WI) with the preservation of epidural fat and a hypointensity on T2WI. A decompressive surgery was scheduled to perform within 2 days after the cervical MRI scan because of a previous anticoagulation therapy, but the patient refused it. Finally, 9 days after the onset, surgical decompression and removal of hematoma were performed. Three months postoperatively, the patient had fully recovered demonstrating fine hand movement and good ability to walk up and down the stairs.
  
  
  CONCLUSIONS
  Our study indicates that it is essential to perform cervical MRI when a patient does not show an improvement in the neurologic deficit and has a negative brain MRI after acupuncture. In addition, blind acupuncture if not correctly practiced may be harmful to the cervical structures.
authors.affiliation: Department of Neurosurgery, University of Ulsan College of Medicine, Ulsan University Hospital, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Ulsan, Republic of Korea.
authors.forename: JunBum
authors.initials: J
authors.lastname: Park
authors.forename: Ryeok
authors.initials: R
authors.lastname: Ahn
authors.forename: DaiSik
authors.initials: D
authors.lastname: Son
authors.forename: BeongSeong
authors.initials: B
authors.lastname: Kang
authors.forename: DongSeok
authors.initials: D
authors.lastname: Yang
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects*; D000208:Acute Disease; D000368:Aged; D019299:Decompression, Surgical; D046649:Hematoma, Subdural, Spinal / Q000150:complications / Q000473:pathology* / Q000601:surgery; D006429:Hemiplegia / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male
keywords: Acupuncture; Magnetic resonance imaging; Spinal subdural hematoma